额窦容积预测颅脑外伤患者脑挫伤的发生率。

Frontal sinus volume predicts incidence of brain contusion in patients with head trauma.

机构信息

From the Departments of Otolaryngology (J.L.Y., C.H.S.), Radiology (B.F.B.), and Neurological Surgery (C.H.S.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

出版信息

J Trauma Acute Care Surg. 2014 Feb;76(2):488-92. doi: 10.1097/TA.0b013e3182aaa4bd.

DOI:10.1097/TA.0b013e3182aaa4bd

PMID:24458055

Abstract

BACKGROUND

The function of the paranasal sinuses is a topic of debate. One hypothesis suggested has been that sinuses act as a "crumple zone," serving to protect the contents of the head from impact. In this study, we examine the interactions of the frontal sinus and the brain in the setting of head trauma. Our formal hypothesis is that frontal sinus volume is less in head trauma patients with contusion than in head trauma patients without contusion.

METHODS

Computed tomographic (CT) scans of patients who sustained blunt head trauma performed at the University of Pittsburgh Medical Center from 2007 to 2012 were reviewed retrospectively. Inclusion criteria were presence of blunt trauma and complete brain and maxillofacial CT scan. Exclusion criteria included patients with incomplete imaging, imaging unrelated to trauma, previous cranial injury, and penetrating trauma.With the use of maxillofacial CT scans, height, depth, and width were measured, and a cubical approximation of volume was determined for each frontal sinus. Presence of frontal sinus fracture was considered an indicator of high-impact trauma. Grading of brain contusion severity was performed using head CT scans. A scale of 0 to 5 was used based on the Marshall Criteria.Categorical data were analyzed using the χ(2) or Fisher's exact test. Continuous data were analyzed using Student's t test or analysis of variance. p < 0.05 was considered statistically significant.

RESULTS

Among patients with frontal sinus fracture, the average sinus volume of those without contusion was 32.72 mL, while the average sinus volume of those with brain contusion was 21.85 mL (p = 0.023). Thus, the volume of the frontal sinuses was 33% less in patients with contusion than in patients without contusion.

CONCLUSION

Our study supports the theory that the frontal sinuses impart a protective advantage against frontal brain contusion. The dynamics of head injury and force distribution during trauma may be the basis for more advanced protective devices.

LEVEL OF EVIDENCE

Prognostic study, level III.

摘要

背景

鼻窦的功能一直是一个有争议的话题。有一种假设认为，鼻窦起到了“吸能区”的作用，保护头部免受冲击。在这项研究中，我们研究了头部创伤情况下额窦与大脑的相互作用。我们的正式假设是，挫伤性颅脑损伤患者的额窦容积小于非挫伤性颅脑损伤患者。

方法

回顾性分析 2007 年至 2012 年期间在匹兹堡大学医学中心因钝器性头部创伤而接受检查的患者的计算机断层扫描（CT）图像。纳入标准为存在钝器性创伤以及完整的脑和颌面 CT 扫描。排除标准包括图像不完整、与创伤无关的图像、既往颅脑损伤和穿透性创伤。使用颌面 CT 扫描测量高度、深度和宽度，并确定每个额窦的近似立方体积。额窦骨折的存在被认为是高冲击力创伤的指标。使用头部 CT 扫描对脑挫裂伤严重程度进行分级。采用基于 Marshall 标准的 0 至 5 级评分。采用卡方检验或 Fisher 确切概率法对分类数据进行分析。采用 Student's t 检验或方差分析对连续数据进行分析。p < 0.05 为差异有统计学意义。